Pd04-05 Vermont Ski Slope: A Novel Technique of Submucosal Bladder Bulking in Sensate Patients With Continent Catheterizable Channels

You have accessJournal of UrologyPediatrics I (PD04)1 May 2024PD04-05 VERMONT SKI SLOPE: A NOVEL TECHNIQUE OF SUBMUCOSAL BLADDER BULKING IN SENSATE PATIENTS WITH CONTINENT CATHETERIZABLE CHANNELS Alexander Plochocki, Brett Giblin, and Gerald Mingin Alexander PlochockiAlexander Plochocki , Brett GiblinBrett Giblin , and Gerald MinginGerald Mingin View All Author Informationhttps://doi.org/10.1097/01.JU.0001008812.05762.7f.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To facilitate catheterization, creation of continent catheterizable channels (CCC's) are often utilized. Despite a functioning CCC, many sensate patients will experience pain during catheterization, which can lead to less frequent or incomplete emptying. We theorize that this is due to the catheter tip hitting the trigone. We hypothesize that redirecting the catheter away from the trigone would reduce the pain with catheterization, resulting in increased compliance. We propose a minimally invasive approach using submucosal injection of Hyaluronic Acid & Dextranomer (HA & Dx) to create a mound (Ski Slope) that deflects the catheter up and away from the trigone. METHODS: All four patients experienced long term pain during intermittent catheterization with new onset lower tract infection, increased hydronephrosis, or incontinence. Parents demonstrated their catheterization technique under ultrasound, where we demonstrated inability to empty due to pain. Patients who experienced pain with catheter advancement proximal to the bladder were not candidates for the procedure. Under general anesthesia via the urethra, we cystoscopically observed the path of the catheter as it entered the bladder. After confirming contact with the trigone, we injected approximately 4-6 cc of HA & Dx at the 6 o'clock position in the bladder just below where the channel entered. We repeated catheterization after creating a 2 cm slope, demonstrating that the catheter tip advanced slightly above the trigone. Patients were discharged home without an indwelling catheter and were allowed to immediately access their CCC's per their pre-op catheterization regimen. RESULTS: We performed five ski slope procedures on four patients; three patients had posterior urethral valves and one patient had non-neurogenic neurogenic bladder. There were no immediate post-operative complications. All patients noted resolution of pain during catheterization. The median duration of follow up is 13.5 months (Range 3-93 months). All remain infection free with a greater than 3-hour period of dryness in one and a significant improvement in hydronephrosis in another. One patient had their initial ski slope in 2014 and started to have catheterization pain again in 2020, which responded to a repeat procedure. CONCLUSIONS: All four patients in this series had reduced pain with major improvement or resolution of the sequela suffered from infrequent or incomplete bladder emptying. This procedure should be considered in this patient population before resorting to open surgical channel revision. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e84 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Alexander Plochocki More articles by this author Brett Giblin More articles by this author Gerald Mingin More articles by this author Expand All Advertisement PDF downloadLoading ...